Liability Insurance Questionnaire For more information, contact us by phone, email, or by using our online form below. The Australian Ceramics member’s liability policy has been arranged to provide the member with high quality Public & Products Liability insurance. The policy can cover Ceramic craft practices. Cover includes members who practice, demonstrate, exhibit, sell and teach their craft on an individual basis to small groups of ten (20) or less people. Please complete this form and follow the instructions to send to City RuralPersonal DetailsName* First Last Trading name* Email Address* Phone* Mobile Phone Website Social Media Preferred method of contact*Select OneEmailPhoneMobileAddress* Street Address City State Post Code Business DetailsTrading Name Postal AddressAddress* Suburb/Town* State* Postcode* Period of Insurance Cover can only commence once full payment and completed application have been received and approvedLimit of Indemnity Required*$10,000,000$20,000,000Description of art form and art related business activities undertaken:*Other DetailsEstimated number per annum ofEstimated number of attendees For Workshop / Classes*Number of Workshops / ClassesNumber of Attendees per Workshop / ClassType of Workshop / Class Estimated number of Exhibitions*Number of ExhibitionsType of exhibition If none please put "0"Number of staff assisting you* Income (estimated for next 12 mths) from Art Form* Are there any hazardous activities, other than kilns, associated with your business? Yes No If Yes provide detailsContractual Liability Coverage for Liability assumed under agreement or contract will be limited to lease liability or liability assumed under a warranty of fitness or quality as regards your products.General DetailsHave you or anyone this policy is to cover (in the past 5 years)1. Suffered any loss or damage or know of a potential claim* Yes No If Yes provide details2. Had any insurance declined or cancelled, proposal/application rejected, renewal refused, claim rejected, special conditions or excess imposed by an insurer?* Yes No If Yes provide details3. Ever been bankrupt or involved in a company or business which became insolvent or subject to any form of insolvency or administration (e.g. liquidation or receivership)?* Yes No If Yes provide details4. Been convicted of any criminal offence within the past 5 years (other than minor traffic convictions)?* Yes No If Yes provide details5. Been liable for any civil offence or pecuniary penalty (exceeding $5,000)?* Yes No If Yes provide detailsDuty of Disclosure In order to make an informed assessment of the risk and calculate the appropriate premium, your insurer needs information about the risk you are asking it to insure. For this reason, before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 to disclose to your insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk and, if so, on what terms. The duty also applies when you renew, extend, vary or reinstate a contract of insurance. You do not have to disclose anything that: Reduces the risk to be undertaken by the insurer; Is common knowledge; Your insurer knows, or in the ordinary course of its business, ought to know; or If the insurer has waived your obligation to disclose. If you do not comply with your duty of disclosure, your insurer may be entitled to reduce its liability in respect of a claim or may cancel your contract of insurance. If the non-disclosure was fraudulent, the insurer may be able to avoid (or cancel) the contract of insurance from its beginning. This would have the effect that you were never insured. One important matter to be disclosed is the history of losses suffered by the person seeking insurance or any closely associated person or entity. As you are responsible for checking that you have made complete disclosure, we suggest that you keep an up to date record of all such losses and claims. I have read the Duty of Disclosure above.* Yes Photo of Art WorksMax. file size: 8 MB.CAPTCHANameThis field is for validation purposes and should be left unchanged.
